Stepping Back to Minimal Footwear

Applications Across the Lifespan

Irene S. Davis; Karsten Hollander; Daniel E. Lieberman; Sarah T. Ridge; Isabel C.N. Sacco; Scott C. Wearing


Exerc Sport Sci Rev. 2021;49(4):228-243. 

In This Article


Although we have identified many of the benefits of minimal footwear use across the lifespan, there is still much more research that needs to be done.

Based on the gaps in the current literature, we need:

  • large-scale prospective studies to compare the effects of conventional versus minimal shoes on foot development, biomechanics, and musculoskeletal health in both children and adults

  • more studies on the effect of minimal shoe use during walking, as well as studies of other activities, on the musculoskeletal system

  • a greater understanding of how to best transition into minimal footwear, including consideration of the adaptive response of tissue in differing foot types (i.e., high arch and low arch)

  • studies of optimal strengthening interventions for the intrinsic and extrinsic muscles to facilitate transition to minimal footwear

  • prospective studies of the effect of intrinsic and extrinsic foot muscle strengthening on foot health

  • studies using advanced methodologies, such as biplanar videoradiography, to study the effect of minimal footwear on the complex motions of the foot

  • studies of the effect of minimal footwear use on foot strength, balance, and falls in older adults

  • studies to determine which pathologic populations can benefit the most from minimal footwear

In summary, modern footwear represents an evolutionary mismatch that may increase the risk for injury. Therefore, we propose the following. Given that we are adapted to being barefoot, habitual locomotion in minimal footwear that is closer to the barefoot condition reduces the vulnerability of the musculoskeletal system to injury. The recent reemergence of minimal shoes was aimed at returning to a more barefoot-like locomotion, which is hypothesized to reduce injury risk. This article has summarized some of the advantages to wearing footwear that minimizes the interference on natural foot mechanics. We have presented evidence of benefits of minimal footwear both across the ages and in pathologic populations. These include stronger foot muscles, stiffer Achilles' tendons, softer landings, better balance, better function, lesser pain, lower knee loads, and reduced lower extremity torques (Figure 10). One of the primary concerns surrounding minimal footwear is the risk of a transition-related injury. It is recommended that those habituated to conventional footwear need to transition into minimal footwear slowly, especially for higher-level activities such as running. Ideally, we start our youth early in minimal footwear so that the body will naturally adapt to it, eliminating any risks associated with transition.

Figure 10.

Schematic of the novel hypothesis that suggests that the use of minimal footwear across the lifespan will result in reduced injuries and a healthier musculoskeletal system. FFS, forefoot strike.